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Cardiopulmonary exercise testing for heart failure: pathophysiology and predictive markers
  1. Jonathan Buber1,
  2. H Thomas Robertson2
  1. 1 Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2 Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr Jonathan Buber, University of Washington Medical Center, Seattle, WA 98195, USA; bubery{at}


Despite the numerous recent advancements in therapy, heart failure (HF) remains a principle cause of both morbidity and mortality. HF with preserved ejection fraction (HFpEF), a condition that shares the prevalence and adverse outcomes of HF with reduced ejection fraction, remains poorly recognised in its initial manifestations. Cardiopulmonary exercise testing (CPET), defined as a progressive work exercise test that includes non-invasive continuous measurement of cardiovascular and respiratory parameters, provides a reliable mode to evaluate for early features and for the assessment of prognostic features of both forms of HF. While CPET measurements are standard of care for advanced HF and transplant programmes, they merit a broader clinical application in the early diagnosis and assessment of patients with HFpEF. In this review, we provide an overview of the pathophysiology of exercise intolerance in HF and discuss key findings in CPETs used to evaluate both severity of impairment and the prognostic implications.

  • heart failure
  • risk factors

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  • Contributors Both JB and HTR contributed to the planning, conduct and reporting of the work described in the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.